Bodies in a Zone of Indistinction:
A History of the Biomedicalization of Pregnancy in Prison
Erica Fletcher
Introduction to the History of Medicine
Fall 2012
Final Paper
Introduction: Current Trends in Women Prisons
The United States’ prison systems house more inmates than any other country in the
Global North.1 Since Nixon’s proclamation of a War on Drugs in the 1960s and Ronald Regan’s
push to create stricter penalties for drug crimes in the 1980s, prisons have seen an influx of
women inmates, with the rate of incarceration increasing six times after this public policy was
enacted.2 To meet the demand, prison systems expanded dramatically and now quarter over
110,000 women prisoners every year—5,000 to 6,000 of whom are pregnant or become pregnant
during their incarceration.3
In prison, pregnant women lack the autonomy to choose their healthcare provider, to
decide the time they are taken to the prison hospital for delivery, and to raise their infant.4 Still,
because federal law states that prisons must provide medical care to all inmates, pregnant
prisoners can expect at least some form of regular checkups and other prenatal care throughout
the duration of their pregnancy.5 In some states across the nation, pregnant prisoners may even
be able to take labor and delivery classes, deliver their babies without being shackled to the
hospital bed, and-- depending on their “good” behavior-- have the option to stay with their
children for a short period in either prison nurseries or residency programs.6 Through these
initiatives, the medical establishment’s encroachment in penitentiaries can be seen as an
1
Steven M. Safyer and Lynn Richmond, “Pregnancy Behind Bars,” Seminars in Perinatology, Vol. 19, No.
4 (August 1995), 314.
2
Ginette G. Ferszt and Jennifer G. Clarke, “Health Care of Pregnant Women in U.S. State Prisons,”
Journal of Health Care for the Poor and Underserved, Vol. 23, No. 2 (May 2012), 557.
3
Paul Guerino, Paige M. Harrison, and William J. Sabol, Statisticians for the U.S. Department of Justice.
Prisoners in 2010. Bureau of Justice Statistics Special Report. (NCJ 236096). (Washington D.C.: United States
Government Printing Office, December 2011, Revised 2/9/2012): 2.
4
Judith Merenda Wismont, “The Lived Pregnancy Experience of Women in Prison,” Journal of Midwifery
& Women’s Health, Vol. 45, No. 4 (August 2000): 295-297.
5
Jenni Vainik, “The Reproductive and Parental Rights of Incarcerated Mothers,” Family Court Review,
Vol. 46, No. 4 (October 2008),676-677.
6
Ella Laura Johannaber, “Teaching Prepared Childbirth to Women in Prison,” International Journal of
Childbirth Education, Vol.21, No. 2 (June 2006), 10-12; Jenni Vainik, “The Reproductive and Parental Rights,”
670-694.
1
“advancement” that institutes policy reformations for a more “humane” approach to ushering life
into prison space.
Regardless, throughout this “progress” narrative, women’s bodies remain a space for
political control and domination in both the spheres of law and medicine. As both spheres fuse
and become co-constitutive of each other, Giorgio Agamben writes, “The novelty of modern
biopolitics lies in the fact that the biological given is as such immediately political, and the
political is as such immediately the biological given.”7 Likewise, in prison, bodies of pregnant
women become zones of indistinction in which both biological and political spheres coalesce and
the very material effects of their engagement are made visible. To that end, analysis of selected
scientific studies will illuminate the ways in which the authority of science (including medicine
and psychology) is co-opted by the medical establishment to make an appeal for more extensive
accommodations of pregnant prisoners. Moreover, this paper will argue that the
biomedicalization of female criminality in the last three decades has created a space in which
certain “liberties” are increasingly afforded to expecting mothers in prison, yet paradoxically this
movement also advances the agenda to moralize, discipline, and control pregnant bodies.
Sketch of Scientific Research and Medicine in Women’s Prisons
The shifting perceptions of female criminals in the nineteenth and twentieth centuries
helped to spur different conceptualizations for the way their time was spent in detention. In the
1800s, female inmates were commonly associated with feeblemindedness, irrationality,
licentiousness, and moral depravity; and these stigmas slowed the fomentation of social
7
Giorgio Agamben, Homo Sacer: Sovereign Power and Bare Life, (Stanford, CA: Stanford University
Press, 1998), 85.
2
movements towards health care reform and other practices in women’s prisons.8 However, with
the rise of the Progressive Era, reformers felt prompted by new discoveries in science and
medicine to make changes in the prison system through empirically-driven research. In tracing
the relationship between scientific applications in the penal system, current efforts in prenatal
care, the unshackling movement, and prison nurseries can be situated within a long lineage of
attempts at prison reformation in the United States.
During the early 1800s, women simply committed fewer violent crimes that warranted
incarceration in state prison systems than men and had little room allocated for them when they
were placed in such facilities.9 Rather, according to historian L. Mara Dodge, they often endured
shorter stays in “local county or city jails, workhouses, or houses of correction.”10 Still, when
they were imprisoned, women were frequently housed in quarters not equipped for residencesuch as attics or basements. Not only were they relegated to poor, cramped housing situations,
they were also often forced to perform domestic chores for the male inmates- such as darning
stockings, sewing, cooking, and cleaning.11 Then, as what happens currently in prisons
throughout the United States, prison guards would often sexually assault inmates, and cases of
illegitimate birth were widespread.12 Moreover, in some states like Indiana, women inmates and
their prison guards engaged in elaborate underground systems of exchanging sexual favors for
special privileges (as they still do today).13
Robert Johnson, Ania Dobrzanska, and Seri Palla, “The American Prison in Historical Perspective: Race,
Gender, and Adjustment,” Prisons Today and Tomorrow, ed. Joycelyn M. Pollock, (Sudbury, MA: Jones and
Bartlett Publishers, 2006), 33.
9
Estelle B. Freedman, Their Sisters’ Keepers: Women’s Prison Reform in America, 1830-1930, (Ann
Arbor, MI: The University of Michigan Press, 1984), 10-11.
10
L. Mara Dodge, “Whores and Thieves of the Worst Kind”: A Study of Women, Crime, and Prisons, 18352000, (DeKalb, Il: Northern Illinois University Press, 2006), 16.
11
Dana M. Britton, At Work in the Iron Cage: The Prison as Gendered Organization, (New York City,
NY: New York University Press, 2003), 28-29; Freedman, Their Sisters’ Keepers, 16.
12
Ibid., 16.
13
Ibid.
8
3
Living in poor, filthy conditions in prison and becoming socialized into a harsh living
environment, inmates often acquired the stigma of being labeled “fallen” women, sinfully
licentious, depraved, and incapable of reforming their ways.14 Considering the influence of
Victorian ideals of femininity as “piety, purity, and submissiveness” as well as a lack of sexual
desire, notions of female criminality falling from that pedestal were common during the 1800s,
and women found it difficult if not impossible to regain their social status once they returned
from their prison sentence.15 Prison, thus, was seen as a holding facility of immorality, a place to
keep women separate from “civilized” society; and as such, Bitton claims that these institutions
stigmatized convicts even more heavily for their crimes against society than they do today.16
What was considered scientific research at the time also furthered concepts of female
criminals as defective degenerates; and through the disciplines of criminology and penology,
women criminals were observed, measured, and categorized by their supposed biological
disposition towards immorality. In 1895, The Female Offender—the work of Italian
criminologists Cesare Lombroso and William Ferrero—did much to classify this population as
biologically determined atavistic throwbacks to lower forms of humans.17 Characterizing them as
masculine, violent, hairy, short, libidinous, Lombroso’s view mirrored ideas among general
audiences in the United States, concerned about potential for social infiltration of racial and
moral degeneration associated with prison populations—most of whom tended to be African
Americans or immigrants to their country.18 According to L. Mara Dodge, similar sexist research
continued even in the 1950s, as Otto Pollak’s The Criminality of Women popularized ideas that
14
Ibid.
Ibid., 19-20.
16
Ibid., 14.
17
Dodge, “Whores and Thieves,” 16.
18
Ibid., 17.
15
4
women were more practiced than men at lying and masterminding criminal activities (as
evidenced by their ability to hide their menstruation every month and fake orgasms).19
Although a new crop of women researchers in the social sciences and other fields
challenged such unsubstantiated research, the claims made by these scientists were not easily
erased in the public imagination. Accepting women into doctoral level programs in the 1890s,
the University of Chicago as well as other progressive schools in the northeast fostered a number
of feminist-minded criminologists, social theorists, social workers, lawyers, and physicians.20
Unlike the generation of women activists before them, they had greater access to education, and
the combination of their work in advocacy and research fed into the larger Progressive Era
movement to use science and medicine as a means of ordering transformation and reorganizing
structures within penal institutions.21
Frances Kellor, trained in criminal sociology, conducted a number of studies on women
inmates at the turn of the century. Replicating Lombroso’s studies, she detected many of his
methodological flaws including a bias that could easily conflate the physical attributes of
particular ethnic groups with those of criminals. Ultimately refuting many of his claims to
biological determinism of female criminality, Kellor took an environmental approach, which
diminished the role of biology in predicting criminality, and considered the “social, mental, and
emotional determinants of crime.”22 In addition, she conducted a number of anthropometric tests,
interviewed prisoners on their life histories, read institutional reports on prisoners, and talked
with prison matrons to learn more about individual prisoners.23 While she was innovative for her
time in acknowledging the role that socioeconomic status played in female criminality, Kellor,
19
Ibid., 17.
Freedman, Their Sisters’ Keepers, 110.
21
Ibid., 125.
22
Ibid., 113.
23
Ibid., 114.
20
5
like many of her colleagues, still took a very individualistic approach to crime that did not fully
acknowledge larger structural barriers to financial independence, educational resources, and
gender equality.24
Katharine Bement Davis also furthered the study of female criminology within prisons;
and as the director of Bedford Hills, the State of New York’s third reformatory, she conducted
intensive research on women’s sex lives before their incarceration and encouraged other
researchers to do similar psychological and anthropological studies there as well.25 With funding
from John D. Rockefeller, she supervised the establishment the Bureau’s Laboratory of Social
Hygiene, a psychological clinic dedicating to eliminating the “social evil” of prostitution.26
Blaming society for the multivariate causes of female criminality—including low moral standing
of men, meager educational, poor sanitation, crowding in cities, low economic conditions, and
few educational opportunities—she too expanded the list of environmental factors to complicate
commonly-held views on the origins of crime. 27
In addition, physicians such as Dr. Edith Spaulding also focused on the etiological causes
of criminality among women by serving as the resident physician at a reformatory at
Framingham, Massachusetts and studying antisocial behavior among psychopathic criminals.28
Disagreeing with Lombroso’s hypothesis that criminals suffered from feeblemindedness, she
concluded that mental deficiency and low intelligence not pervasive among all or even most of
female prisoners and did not act as a causal factor in instigating crime.29 Rather, as historian
Estelle Freedman notes Dr. Spaulding found through her research that, “Environmental factors,
24
Ibid., 115.
Ibid., 117-118.
26
Ibid., 18.
27
Ibid., 117.
28
Ibid., 119-120.
29 Ibid.
25
6
including poverty, parental death, incest, and either prostitution or alcoholism at home appeared
in 45 percent of the cases.”30 In this manner, her work also problematized simplistic, hereditary
etiologies of criminality and led to new ways of conceptualizing and treating criminality.
The effects of scientific research, social science, and law greatly altered the treatment of
criminals during the early 1900s, and researchers such as Frances Kellor, Katharine Bement
Davis, and Dr. Edith Spaulding helped to shift focus from biological causes to social causes of
criminality. While they were not always able to identify larger structural causes of structural
inequality that contributed to criminality, these women were highly cognizant of the dire
socioeconomic conditions that many prisoners faced in the free world, disputed theories of
criminal heritability, and detailed more nuanced accounts of environmental factors correlated
with criminality. Finally, their work provided early contributions to a vast amount of research
that is still conducted upon women prison populations today.
Although the inculcation of norms of proper femininity remained central components in
prison life, Samuel Pillsbury explains how the medical model became critical to further
Progressive Era ideology and rehabilitation programs for criminals:
Crime was described as a disease suffered by the offender; what followed
conviction should be its cure. The offender was not a sinner but a sick person,
a patient in the care of the physician state. In its strongest form, idealist
ideology of the period rejected the notion of criminal responsibility, arguing
that the crime was an act beyond the control of the criminal and that the attempt
to apportion punishment according to its severity was not only hopeless, but a
throwback to the primitive retributivism of earlier times.31
This method thus called for a more individualized treatment of the prison, in which not only the
judge would help to determine one’s sentence, but parole officers and social scientists would also
30
Ibid., 120.
Samuel Pillsbury, “Understanding Penal Reform: The Dynamic of Change,” The Journal of Criminal
Law and Criminology 80, No. 3 (Autumn 1989), 742-743.
31
7
determine the manner in which a sentence would be enforced.32 Although this method was never
fully realized during the early 1900s, such idealistic policy formed according to the best
recommendations of social science and medicine was highly indicative of the Progressives’ sense
of optimism and their deep faith in science.33
Moreover, the emerging research from social sciences as well as from other fields,
strengthened the idea that it was possible to “civilize” women inmates. Detailing this shift, L.
Mara Dodge explains:
This emerging medical model embodied a faith in scientific classification,
psychiatric diagnosis, intelligence testing, and eugenics doctrines.
Progressive Era reformatory administrators represented a new generation
of college-educated, professional women, who viewed their charges not so
much as “sisters,” but as difficult clients in need of segregation, medical
and psychiatric treatment, educational and vocational training, and, at
times, sterilization and permanent institutionalization.34
As the first wave of feminists gathered in strength, and the Progressive Era (roughly 1900-1920)
swept the nation, new research shifted perceptions of female criminality as well. Instead of
seeing criminals as irreversibly “defective degenerates,” some women reformers began to view
these women criminals as “poor unfortunates,” capable of receiving moralizing lessons to teach
them middle-class (Christian) values of domesticity; and they retained the hope that these
deficient women could be trained to engage with society as “proper” ladies.35 With the gradual
establishment of separate women’s prison from approximately 1870 to 1900, new spaces to
practice such ideals emerged.36
In her well-known book on the history of women’s prison reform, Their Sisters’ Keepers,
Freedman provides the following summary of the moralizing component of prison reform:
32
Ibid., 743.
Ibid.
34
Dodge, “Whores and Thieves,”19.
35
Ibid., 127-139.
36
Freedman, Their Sisters’ Keepers, 46-52.
33
8
The term “prison reform” has come to refer to efforts to improve prison
conditions, but it has a more basic meaning as well: the use of prisons to
re-form, rather than merely to detain, criminals. Advocates of prison
reform in the early nineteenth century favored the establishment of prison
which, through their influence on prisoners’ behavior, would encourage
repentance. The penitentiary, they believed, best combined the goals of
punishing criminals and re-forming their characters so that they would not
break the law again.37
Responding to the call to transform their prison systems, some penitentiaries in the 1930s
through the mid 1950s were built on the feminizing ideal of cottages, in which women could
practices domestic chores such as cooking, cleaning, farming, and sewing in the comfort of
home-like settings.38 Allocated a small room, each inmate was expected to perform certain
household duties under the supervision of the cottage warden.39 However, this system also
provided an opportunity for unprecedented surveillance, and as the cottage model became further
systematized, inmates were cited for a number of petty occurrences such as failure to drink
coffee and eat toast at breakfast or sneaking extra pieces of cake, as well as major infractions
such as fighting and possessing contraband items.40
Despite their initial success, the reformatory models eventually became more prison-like
in nature. Filled to capacity, efforts to educate women in middle-class values and Protestant work
ethics became more challenging as more women were sentenced to re-formation.41 As state
budgets tightened, correctional models became prevalent as they offered more affordable
methods to house larger populations, without the costly goal of character reformation. Moreover,
the perceptions of women inmates had again shifted towards one of hardened criminals,
Dodge, “Whores and Thieves,”8.
Ibid., 209.
39
Ibid., 201-204
40
Ibid., 204-219.
41
Britton, At Work in the Iron Cage, 41
37
38
9
incapable of reformation after all.42 Still, as Dana Britton notes, reformatory ideology “continues
to occupy an ingrained, if ambivalent, space in our thinking about women prisons.”43
Although scientific research has continued throughout prisons in the United States,
approaches in social science to understanding the etiology of crime have fallen out of vogue as a
means to reform prison systems. According to Samuel Pillsbury, in 1964 the Supreme Court
“abandoned the deference to social science expertise which it had displayed earlier and
undertook a careful review of penal decisionmaking.”44 The previously-used rehabilitation model
sought to rehabilitate prisoners from their fallen state and allowed some discretion on the part of
prison administrators for determining prison sentences. However, since many advocates believed
that such determinations were highly subjective and biased, this model was eventually replaced
by determinate sentencing, which provided more strict guidelines for lengths of incarceration.45
Still, among several other changes during the 1970s and 1980s, since Estelle v. Gamble in
1976, lawsuits filed under the violation of the Eighth and Fourteenth Amendments have brought
about additional health care protocol for all prisoners requiring medical interventions, including
women.46 Now, in correctional institutions operated by the Federal Bureau of Prisons, women
are able to access health care services such as immunizations, STI testing, pap smears, and
pregnancy tests, according to certain guidelines established by the American College of
Obstetrics and Gynecology.47 In state prisons, however, access to health care remains varied and
ambiguous.48 According to Jenni Vainik, many women are still “routinely denied the support
42
Ibid.
Ibid.
44
Pillsbury, “Understanding Penal Reform,” 753.
45
Ibid., 755.
46
Tammy L. Anderson, “Issues in the Availability of Healthcare for Women in Prison.” Pp. 49-60 in The
Incarcerated Woman: Rehabilitative Programming in Women’s Prisons, edited by S. F. Sharp and R. Muraskin.
(Upper Saddle River, NJ: Prentice Hall, 2003): 1-9.
47
Ibid., 7.
48
Vainik, “The Reproductive and Parental Rights,” 676-677.
43
10
necessary to achieve healthy pregnancies and maintain relationships with their children in
prison,” and research indicates, “inmates often are unable to access care, available services are
inadequate, and providers are insensitive to female inmates’ emotional needs.”49 Moreover,
despite limited developments, women’s health care still lags behind services provided to men in
prison, and women often lack the legal representation necessary to demand greater access to
care.50
In this brief sketch, it becomes clear that the ways in which science and medicine
interacted with the United States’ penal system were highly contingent on cultural views of the
time towards criminality. While scientific efforts during the Progressive Era brought hope that
fallen women could be restored to society, the moralizing campaigns of biological determinism
and the eugenics movement cannot be forgotten as well. Moreover, while women social
scientists gained traction in challenging past ideas of hereditarianism, they often ignored the
systematic barriers of racism, sexism, and classism that many women inmates experienced
during this time. While science did much to effect prison reform during the Progressive Era, its
decline in the 1960s is also indicative of shifting perceptions of criminality, and current views
towards criminality seem to indicate a much more conservative stance on the ability of
institutions to reform prisoners. However, as scientific research, social work, and medical
initiatives continue in the prison, the rehabilitative model still holds some sway among medical
practitioners and political activists interested in the health and wellbeing of female prisoners.
49
50
Ibid., 676.
Anderson, “Issues in the Availability,” 3.
11
Biomedicalization Normalized
To better understand the inroads that medicine has made upon the prison system, it is
important to first trace the ways in which medicine and law legitimate each other. Charting
trajectories of power in the twentieth century, Michel Foucault describes how the judicial arm of
the State becomes normalized into society through medicine:
I do not mean to say that the law fades into the background or that the
institutions of justice tend to disappear, but rather that the law operates
more and more as a norm, and that the judicial institution is increasingly
incorporated into a continuum of apparatuses (medical, administrative,
and so on) whose functions are for the most part regulatory.51
As law becomes hidden through medical imperatives, Foucault also argues that medicine
augments its authority through law. This exchange allows both spheres of influence to validate
each other’s existence and grow in power and prestige, and together their presence within prison
systems makes it difficult to separate out the imperatives of the state and of medicine.
The medicalization of certain biological processes, such as pregnancy, has been used as a
means of social control. Defining this process in terms of medical ideology, collaboration, and
technology, Peter Conrad writes, “Simply stated, medical ideology imposes a medical model
primarily because of accrued social and ideological benefits; in medical collaboration doctors
assist (usually in an organization context) as information providers, gatekeepers, institutional
agents, and technicians; medical technology suggests the use for social control of medical
technological means…”52 Applying these overlapping categories to the medicalization of
childbirth in prison, the combination of the pervasive ideology that medicine as advantageous to
expecting mothers and the growth of medical technology in obstetrics lend themselves to
supporting health care professionals as institutional agents for prisons. As institutional agents,
Michel Foucault, “Right to Death and Power Over Life,” Part Five of The History of Sexuality, Vol. I: An
Introduction, (New York City, NY: Random House, Inc., 1978), 144.
52
Peter Conrad, “Medicalization and Social Control,” Annual Reviews of Sociology, Vol. 18 (1992): 216.
51
12
health care professionals are placed at times in a difficult position to balance and uphold both
medical imperatives to regiment health and healing and the imperatives of the prison to
discipline and punish.
More recently, biomedicalization has become the new language through which scholars
discuss a societal transformation occurring “…from the inside out through old and new social
arrangements that implement biomedical, computer, and information sciences and technologies
to intervene in health, illness, healing, the organization of medical care, and how we think about
and live ‘life itself.’”53 To provide a few examples of this trend, in more recent years, the modes
of risk and surveillance during the pregnancy process have expanded from basic Leopold’s
Maneuvers to encompass imaging technologies of MRIs, intravaginal ultrasound, 3D/4D
ultrasound, and telemedicine. Explaining this phenomenon, Ian Whitmarsh and David Jones
write: “The state increasingly defines citizens by their biology, through prenatal testing, newborn
screening, and government use of biometrics to determine medical access. Governance here is a
mix of commerce and civic institutions acting on an individual subject.”54 Through these
methods, Whitmarsh and Jones argue that recent applications of technology and knowledge
allow women’s bodies to be seen more closely; and through such techniques of surveillance,
public policies can be manifested upon the body.
Likewise, within the prison system, the authority of the medical establishment has gained
traction in implementing their specialized knowledge upon women’s bodies. To this end,
Elizabeth Grosz describes the power of such knowledge and how it shapes systems of
governance:
53
Adele E. Clarke, Janet K. Shim, Laura Mamo, Jennifer Ruth Fosket, and Jennifer R. Fishman,
“Biomedicalization: A Theoretical and Substantive Introduction,” Biomedicalization: Technoscience, Health, and
Illness in the U.S., (Durham & London, UK: Duke University Press, 2010), 2.
54
Ian Whitmarsh and David S. Jones, What’s The Use of Race? Modern Governance and the Biology of
Difference, (Cambridge, MA: The MIT Press, 2010), 16.
13
… knowledge is one of the conduits by which power is able to seize
hold of bodies, to entwine itself into desires and practices: knowledge
devises methods for the extraction of information from individuals
which is capable of being codified, refined, reformulated in terms of
and according to criteria relevant to the assessment of knowledge. As
legitimized and sanctioned knowledge, discourse are then able to feed
back into the regimes of power which made them possible and to enable
power to operate in more subtle or systematic, more economical or
vigilant, forms.55
Medicine, as legitimized and sanctioned knowledge, forms a conduit of power through which to
shape the prison system. Similarly, Agamben states, “…the biopolitical horizon that
characterizes modernity, the physician and the scientist move in the no-man’s land into which at
one point the sovereign alone could penetrate.”56 In the no-man’s land of prison, the pregnant
inmate remains a zone of indistinction in which the physician and the scientist have begun to
tread. The recent movements in medicine to advocate for prenatal care in penitentiaries, a ban on
shackling practices, and prison nursery/residency facilities not only increase this zone of
indistinction but also reflect larger societal trends in adopting and projecting the
biomedicalization of pregnancy upon prison systems (the Sovereign).
Pregnancy In and Out of Prison
An analysis of medical articles written in the past three decades on pregnancy in prison
reveals the ways in which medical doctors and social researchers conceptualized a tension
between the role of a prisoner, the role of the patient, and the role of a mother. Many scholars
write that there was a strong cultural contradiction between being expected to provide care and
nurturance for infants and children, and being forced to submit to totalitarian regimes of power in
an overwhelmingly hostile environment. In the “free” world, mothers face the cultural
contradiction between the expectation to practice what Sharon Hays calls “intensive mothering”
55
Elizabeth Grosz, Volative Bodies: Towards Corporeal Feminism, (Bloomington, IN: Indiana University
Press, 1994), 148.
56
Agamben, Homo Sacer, 91.
14
and another expectation to fulfill the 1960s and 1970s feminist dreams to be careerists on
equitable footing as men in work environments. 57 In prison, mothers subvert both roles, which
can only be attempted in the “free” world, and are thus further shamed by their inability to
perform “good” mothering. In reading elaborations on the tensions within performativity, it
becomes clear that the medical researchers also place pregnant prisoners and incarcerated
mothers in a zone of indistinction, yet within this zone they argue for an increased medical
presence and other social programs in the women’s lived experience as a way of coping with the
stressors of prison life and maintaining a sense of individuality.
While many of these authors recognize the larger social injustices of the prison systems
and the public policies and corporate structures that have led to increased rates of incarnation,
these factors seemed too large and imposing to address at the medical level. (In one instance,
completely ignoring the sociological factors that contribute to an expanding definition of
criminalization, a medical researcher took the position that the increasing rates of female
incarceration further enhance his argument that medical intervention is even more necessary
within prison.58) Still, the prevailing notion remains one of complacency in the belief that the
knowledge of medicine can work in tandem with the authority of law, and that it can achieve
shared goals of creating “good” citizens and mothers.
One article written for the International Journal of Obstetrics and Gynaecology notes the
irony that prisoners have better health outcomes than women in the “free” world of the same low
socioeconomic status.59 Although the authors do not mean to imply that more women should be
57
Sharon Hays, The Cultural Contradictions of Motherhood, (New Haven, CT: Yale University Press,
1996), 1-18.
58
Safyer and Richmond, “Pregnancy Behind Bars,” 314-321.
59
Marian Knight and Emma Plugge, “The Outcomes of Pregnancy among Imprisoned Women: A
Systematic Review,” BJOG: an International Journal of Obstetrics and Gynaecology, Vol. 112, (November 2005),
1467-1474.
15
incarcerated as a means to achieve better birth outcomes, they do suggest that life is so chaotic
and unstable out of prison that in terms of preventing stillbirth or low birth-weight for infants
“imprisonment may have a beneficial effect.”60 This sort of rhetoric legitimates medicine’s
existence in prison systems, yet it also provides a very narrow scope of conceptualizing medical
advocacy that refuses to examine the larger structural inequities and public policies within the
“free” world that fails to provide adequate health care access and that contribute to increased
criminalization of women inmates.
Through this normalizing discourse, the following quote from the concluding statements
of Judith Wismont’s qualitative study of pregnant inmates in 2000 can be contextualized:
The rapidly rising number of women imprisoned in the United
States underscores the urgency to better understand their experiences.
HCPs (Health Care Professionals) must talk with pregnant incarcerated
women to more fully understand the experience of childbearing in
prison. A way must be found to help imprisoned women cope more
effectively with the role diffusion/confusion they experience as they
live two diametrically opposing roles—those of inmate and mother.
Incarcerated mothers must be assisted to identify their strengths and
set personal goals. Correction authorities must be encouraged to
establish care guidelines that recognize the unique needs of pregnant
incarcerated women.61
Although Wismont attempts to employ techniques of “phenomenological reduction” to express
“scientific exactness” for which she strives, her account of women’s accounts of pregnancy
within prison is unable to present a narrative with “all subjective influences removed.”62 As a
health care professional herself, she believes in the duty she and her colleagues have to listen to
the narratives of their incarcerated patients (which could be read as increased surveillance of
their affect) as a means to grapple with an assumed tension they experience in maintaining the
60
Ibid., 1467.
Judith Merenda Wismont, “The Lived Pregnancy of Women in Prison,” Journal of Midwifery &
Women’s Health, Vol. 45, No. 4 (August 2000), 299.
62
Ibid., 293.
61
16
roles of expecting inmates. Furthermore, she implies that medical professionals should act as
witnesses (surveyors) and life coaches (discipliners) to encourage inmates to achieve goals
(presumably to aid in their normalization process and reintegration into “free” society). Speaking
to an audience interested in midwifery and women’s health issues, she advocates for their
increased attention to women’s needs in prison and calls for the policy change in correctional
facilities through the logos of medical advice.
Likewise, writing to a medical audience in perinatology, Steven Safyer and Lynn
Richmond also participate in a similar medical discourse to normalize mothering in prison:
With the pressures overburdening the criminal justice system,
increasingly precious resources need to be invested in community
programs that will provide pregnant women with a structured
environment, prenatal care, good nutrition, and most critically,
drug treatment, with transitional assistance to self-sufficiency…
At the very least, programs need to be developed and sustained
that integrate jails and prisons with health, educational, and social
services in the community.63
Although the authors recognize the sociological barriers for mothers attempting to access
resources in (and outside of) prison, they continue to place responsibility on individual inmates
to get to a place of “self-sufficiency.” This truncated perspective of accountable mothering can
easily be read as a means to not only perpetuate dependency upon state welfare programs
(including medical care) but also a sense of distrust that women are not able to be suitable
mothers without such a “structured environment.” Even these researchers who recognize the
“complex stories of unfinished lives, of victimization and abuse, of poverty and exploitation, of
cyclical and generational obscurity, of classism and sexism, and of stigma and shame,” still
63
Safyer and Richmond, “Pregnancy Behind Bars,” 321.
17
suggest more invasive interventions creating “good” mothers through parenting classes,
mentorship classes, drug addiction support, and community-based programs.64
Moreover, many medical professionals and social researchers are interested in the
familial effects of incarceration among inmates with infants and children. Tracking the high
school dropout rate and other markers of educational difficulties among teenage children of
incarcerated mothers seems to indicate a persistent correlation between maternal incarceration
and negative effects upon children’s mental health and scholastic achievement.65 Thus, both in
and out of prisons, the lives of past and present offenders are being tracked for the potential longterm political impact that they and their offspring may have on other spheres of social welfare
programs.
Prenatal Care and Labor Preparation
While federal, state, and local prisons’ policies greatly differ in treating women’s health
and prenatal care in prison, many public health articles indicate that better nutrition, regular
checkups with a physician, and birthing classes would be beneficial for expecting mothers. At
this microlevel of intervention, the results might prove highly successful, but troubling questions
remain about the greater political system that labeled many expecting mothers and other women
as criminals in the first place. Nevertheless, in adding to the body of research encouraging
medical initiatives within this system, those in the healthcare professions legitimate their own
roles within the prison and seek novel opportunities to exert control over prisoners’ bodies.
Suzanne Allen, Chris Flaherty, and Gretchen Ely, “Throwaway Moms: Maternal Incarceration and the
Criminalization of Female Poverty,” Affilia: Journal of Women and Social Work, Vol. 25, No. 2 (2010), 170.
65
John Hagan and Holly Foster, “Children of the American Prison Generation: Student and School
Spillover effects of Incarcerating Mothers,” Law & Society Review, Vol. 46, No. 1 (2012), 37-62; Rosa Minhyo
Cho, “Maternal Incarceration and Children’s Adolescent Outcomes: Timing and Dosage,” Social Service Review,
Vol. 84, No. 2 (June 2010), 257-282; Stephanie Bush-Baskette, “The War on Drugs and the Incarceration of
Mothers,” Journal of Drug Issues, Vol. 30, No. 4 (Fall 2000), 923-924; Vainik, 682-683.
64
18
Ella Johannaber, a birthing instructor in Georgia, understands the larger structural
barriers to healthcare that expecting mothers face, yet her point of intervention primarily remains
at the level of providing childbirthing classes for pregnant prisoners. To this end, she writes,
“Advocacy is clearly needed for change…On the other hand, change cannot happen soon enough
for the women who are presently bound by these policies and practices. Even while we advocate
for change there are women within the system who will have their babies in appalling conditions
without benefit of childbirth education.”66 Calling for furthering advocacy for improvement to
prison and for participating within the system, Johannaber takes a gradualist approach towards
activism and sees her work in facilitating childbirth as a point of intervention as well. Perceiving
limits to what her role as an educator, she asks:
How can a childbirth educator make a difference? We can not immediately
change the unjust aspects of the prison environment. What we can offer is a
compassionate presence that lets the woman know she is not along, she is not
forgotten… Each prison is different and the degree of openness to change,
and the channels for change to happen, varies. By being present within the
system, we become knowledgeable about what is happening and are then
poised to be a catalyst for change.67
While it is certainly clear that Johannaber has good intentions for the very important work she is
doing within prison, it seems like the difference she makes is still premised on changing
individual prisons and thinking about the prison itself as a static entity, a-historical reality and
does not consider the moments in the last thirty years that have increased prison populations
dramatically. Moreover, the question remains—what larger discourses of power and control is
she supporting in the action of continuing a very narrow approach for becoming a “catalyst for
change” within a particular prison? Is a more radical approach to “change” possible without
greater political activism?
66
67
Johannaber, “Teaching Prepared Childbirth,” 10.
Ibid., 11.
19
As researchers in public health conducting a nation-wide survey of the United States on
women’s healthcare, Ferszt and Clarke take a similar gradual approach to change as Johannaber
when they make the following recommendations to care for pregnant inmates:
Based on the nineteen responses to our survey, nutrition actually provided
is inconsistent with the dietary recommendations for pregnancy, adequate
rest is compromised and two mattresses are rarely provided. Departments
of Corrections must develop policies ensuring that pregnant women have
two mattresses, are given lower bunks, and meet with the nutritionist to
discuss and plan a healthy diet to meet the nutritional standards for pregnant
women. A written nutritional educational pamphlet for pregnant women is
an additional resource that can be used.68
In focusing intervention on the nutrition of only pregnant women, they overlook likely
nutritional deficits of other prisoners. Moreover, in suggesting private meetings with a
nutritionist, they both systematize the role of a healthcare professional within prison and further
a neoliberal discourse that focuses on a prisoner’s individual responsibility to control their diet,
despite a setting in which they have little nutritional options.
Likewise, researchers working for the American Civil Liberties Union of Texas (ACLU)
and the Texas Jail Project (TJS) also imply that greater medical surveillance is needed within the
state’s prisons and place great responsibility on security personnel to receive some medical
education on labor in order to prevent the baby from being born in a prison cell. The following is
an excerpt from the recommendations they make for further medical training (encroachments)
within prison:
1. Security personnel must be trained to recognize labor. Security personnel
cannot be expected to have extensive medical knowledge. However, to
avoid liability and keep inmates healthy, security personnel should be trained
to recognize medical emergencies, including the onset of labor. Security
personnel can be educated through the distribution of fact sheets with key
information on how to recognize labor, workshops for security staff taught by
medical staff, and inclusion of this information in the initial training for
security personnel. In order to increase compliance with the law, TCJS
68
Ferszt and Clarke, “Health Care,” 565-567.
20
should consider adopting this training as a best practice for all Texas jails.69
The ACLU of Texas and TJP further propose that all medical decisions be
left to licensed medical staff. In jails where medical staff is available around the
clock, security personnel should be required to notify medical staff immediately
of any problems experienced by a pregnant inmate so that medical staff can
determine whether the inmate is in labor even before she is transported to the
hospital. In all jails, but most importantly in those that do not have the resources
to provide 24/7 medical staff, security personnel must be educated on how to
recognize labor.70
In the excerpt, it is interesting to note that the risk of avoiding liability precedes the other
imperative to “keep inmates healthy.” Rather than discussing the moral responsibility the state
has towards ameliorating the health of those whose freedom they take away, the rhetoric of
liability serves as a very truncated argument for strongly encouraging security personnel to heed
expecting mothers’ calls when they say they may be in labor. In addition, these organizations
also continue to reify the role of medicine in declaring that “all medical decisions be left to
licensed medical staff” and that security personal personally should defer to the medical staff if
there is any question of “medical emergency” (which they consider the onset of labor to be).
In addition, the ACLU and the TJP’s other recommendations to codify medical guidelines
in the prison, conduct assessments to make certain that these guidelines are followed, and
administer adequate healthcare for pregnant inmates read as follows:
1. Ensure consistent, proper care for all pregnant inmates incarcerated in
county jails with standardized and specific policies.
2. Empower the Texas Commission on Jail Standards fully to review
medical plans, speak with pregnant inmates, and generally ensure medical
care is sufficient.
3. Ensure appropriate medical care for pregnant inmates by establishing
policies with timelines for initial screenings, provisions for ongoing and
follow-up care, and measures to address high-risk pregnancies and obstetric
emergencies.
69
*Texas Criminal Justice System
Andrea Bos, Matthew Simpson, and Diana Claitor, “Implementation of Laws Regarding Treatment of
Pregnant Women in Texas County Jails: A Review of the Shackling Ban and Pregnant Inmate Care Standards,
American Civil Liberties Union of Texas & Texas Jail Project (August 2011), 5.
70
21
4. Ensure appropriate mental health care for pregnant inmates, including
addressing existing mental health issues and monitoring inmates for postpartum depression.
5. Standardize nutritional, housing and work assignment policies to ensure
the health of fetuses and newly-born children across the state, [sic]71
By proposing that the Texas Commission on Jail Standards to oversee the medical treatment and
psychological care provided and speak with inmates about their access for and compliance with
healthcare recommendations, this policy adds further layers of surveillance and discipline, both
on the part of the healthcare providers at the prison and of the inmates themselves. Moreover,
creating further protocol would rigidify further powerful networks of public policy for prison
staff and inmates to meet and be judged against. Finally, even fetuses and newborns are also
implicated in the suggested network of surveillance, as the standardization of nutritional,
housing, and work assignment policies is implicitly correlated with and measured by the health
of these infants. Such recommendations thus enforce the will to monitor and control the actions
of prison administrators, inmates, and even the inmates’ children.
Furthermore, making these small interventions to improve the situation of pregnant
prisoners (though important) may do so at the cost of addressing the larger problems inherent in
the prison complex. By taking a stance that is not too politically charged, however, researchers
like them may be able gain access into prisons, suggest policies that are relatively
uncontroversial, and continue to make similar recommendations to gradually ameliorate the
implementation of healthcare in prison. In this manner, such researchers are implicated in the
growth of the medical-prison complex.
71
Ibid., 16.
22
Unshackling Movement
In recent years, the unshackling movement has gained momentum in many states as they
reevaluate their policies on restraining pregnant women during their labor and delivery. Aided by
media groups disseminating information about past travesties of prisons that neglected pregnant
inmates calls for medical help and that the use of restraints caused complications during their
labor, the publicity received from these new stories has led to a number of states passing antishackling laws in their states.72 Buffered by the support of advocates in healthcare professions,
the logos of medical recommendations have helped to shape the argument for passing such laws
across states.
New York’s Anti-Shackling Bill, passed in 2009, develops a similar medical rhetoric
used in recommendations for improving prenatal care and labor preparation. By mandating that
prison personnel following medical advice in the treatment of inmates during labor, this law
seemingly places medical authority and the health of women as higher imperatives than the
prison’s correctional purposes:
NO RESTRAINTS OF ANY KIND SHALL BE USED WHEN SUCH
WOMAN IS IN LABOR, ADMITTED TO A HOSPITAL, INSTITUTION
OR CLINIC FOR DELIVERY, OR RECOVERING AFTER GIVING BIRTH.
ANY SUCH PERSONNEL AS MAY BE NECESSARY TO SUPERVISE
THE WOMAN DURING TRANSPORT TO AND FROM AND DURING
HER STAY AT THE HOSPITAL, INSTITUTION OR CLINIC SHALL
BE PROVIDED TO ENSURE ADEQUATE CARE, CUSTODY AND
CONTROL OF THE WOMAN. THE SUPERINTENDENT OR SHERIFF
OR HIS OR HER DESIGNEE SHALL CAUSE SUCH WOMAN TO BE
subject to [her] return to such institution OR LOCAL CORRECTIONAL
FACILITY as soon after the birth of her child as the state of her health will
permit AS DETERMINED BY THE MEDICAL PROFESSIONAL
RESPONSIBLE FOR THE CARE OF SUCH WOMAN.73
72
Cristina Constantini, “Should a Woman Be Shackled While Giving Birth? Most States Think So.” ABC
News, October 10, 2012. Accessed December 13, 2012. http://abcnews.go.com/ABC_Univision/News/womanshackled-giving-birth-states/story?id=17436798#.UMqazs2IBzM.
73
S.1290-A/A.3373-A, Montgomery/Perry Anti-Shackling Bill, by Senator Velmanette Montgomery and
Assemblyman Nick Perry of the State of New York (passed 2009).
23
Despite her being under the supervision of medical professionals, this law’s call for penal
supervision to ensure the “care, custody and control” of the inmate still evokes the prison’s
language of discipline, and the very administration of medical care remains deeply engaged
within the political spheres of prison through act of possessing the custody and control “OF THE
WOMAN.” In this manner, the woman’s body is still objectified as a risk, a site in need of
control of both medical and penal supervision.
Texas state law Section 501.066 also bans the use of restraints during labor and delivery,
but provides the following stipulations for prisoners deemed likely to harm others or to escapes
from the hospital:
Sec. 501.066. RESTRAINT OF PREGNANT INMATE OR DEFENDANT.
(a) The department may not use restraints to control the movement of a
pregnant woman in the custody of the department at any time during
which the woman is in labor or delivery or recovering from delivery,
unless the director or director’s designee determines that the use of
restraints is necessary to:
(1) ensure the safety and security of the woman or her infant,
department or medical personnel, or any member of the public; or
(2) prevent a substantial risk that the woman will attempt to escape.
(b) If a determination to use restraints is made under Subsection (a), the
type of restraint is used must be the least restrictive available under the
circumstances to ensure safety and security or to prevent escape.74
This section of the law indicates that the state still has greater authority than medical professions
if the pregnant inmate is deemed to be a threat for those in the hospital or a risk for escaping into
the free world. Under the auspices of “safety and security,” the state’s imperative to maintain
possession of its pregnant inmates under perpetuates the idea that attention must be paid at all
times, and that even while in labor these women present potential threats to herself, “her infant,
department or medical personnel, or any member of the public.” Thus, at least in Texas, the will
to secure the pregnant inmate labeled hazardous trumps medical advice to provide her an
74
Texas Law, § 501.066 Restraint of Pregnant Inmate or Defendant, (passed Sept. 1, 2009).
24
experience of labor and deliver without restraints.
In Florida, a proposed bill relies heavily on medical advice to advocate for outlawing
shackling practices in state prisons:
WHEREAS, restraining a pregnant prisoner can pose undue health
risks and increase the potential for physical harm to the woman and her
pregnancy, and
WHEREAS, the vast majority of female prisoners in this state are
nonviolent offenders, and
WHEREAS, freedom from physical restraints is especially critical
during labor, delivery, and postpartum recovery after delivery as women
often need to move around during labor and recovery, including moving
their legs as part of the birthing process, and
WHEREAS, restraints on a pregnant woman can interfere with the
medical staff’s ability to appropriately assist in childbirth or to conduct
sudden emergency procedures, and
WHEREAS, the Federal Bureau of Prisons, the United States Marshals
Service, the American Correctional Association, the American College of
Obstetricians and Gynecologists, and the American Public Health Association
all oppose restraining women during labor, delivery, and postpartum recovery
because it is unnecessary and dangerous to a woman’s health and well-being,
NOW, THEREFORE,
Be It Enacted by the Legislature of the State of Florida:
Section 1. Shackling of incarcerated pregnant prisoners.—
(1) SHORT TITLE.—This section may be cited as the “Healthy
Pregnancies for Incarcerated Women Act.”75
In this bill (unlike Texas’s law), shackling is considered a threat for “physical harm” to the
inmate and “dangerous to a woman’s health and well-being.” Recognizing the nonviolent nature
of most female prisoners, the “critical” importance for freedom from constraints during labor,
and the threat restraints pose in the advent of “sudden emergency procedures,” the bill claims
the language of “health” to advocate for altering the Florida prison system. Moreover, in evoking
the policy recommendations of the American College of Obstetricians and Gynecologists
(ACOG) and the American Public Health Association (APHA), this bill gives credence to the
75
Florida Bill, S.B. 524 Restraint of Incarcerated Pregnant Women (2012), by Senator Arthenia Joyner.
25
power of medical authorities to help inform the manner in which healthcare is administered for
prisoners.
As healthcare professionals make inroads into changing policies in prison to better serve
the goals of medicine, they must often negotiate the imperatives of prisons as well. While some
states like New York give more credence to physician’s advice, states like Texas have TDCJ
supervisor determine whether or not pregnant women pose enough threat to receive shackles
during labor, and the treatment of the prisoner ultimately remains the State’s power. Likewise, in
states like Florida, the recommendations given by the ACOG, the APHA, and other professional
health organizations clearly hold greater sway than in other states for passing laws against
shackling. Through reading the bills and amendments, the co-constitutive nature of medicine and
law becomes quite evident here as well.
Motherhood in Prison
After delivery, some inmates have the opportunity to see their infants through prison
nursery and residency programs, which allow mothers to stay with their infants between a
maximum of 30 days to 36 months.76 Advocacy surrounding the advent of these programs has
centered on psychological and sociological studies conducted on women participating in prison
nurseries, and medical endorsements to expand “scientific” research to further motherhood
initiatives carry great clout as “evidence” for best practices in prison. The following excerpts
from such studies also indicate a biomedical system of quantification of something as ephemeral
as well-being within prison and a financial quantification of less State spending with lower
recidivism rates.
Chandra Kring Villanueva, “Mothers, Infants and Imprisonment: A National Look at Prison Nurseries
and Community-Based Alternatives,” Women’s Prison Association, Institute on Women & Criminal Justice (2009),
10.
76
26
Studying the bonding patterns of infants with mothers in a prison nursery, researchers
Byrne, Goshin, and Joestl found that infant attachment style was not dramatically different from
those in the “free” world:
Using intergenerational data collected with rigorous methods, this study
provides the first evidence that mother in a prison nursery setting can raise
infants who are securely attached to them at rates comparable to healthy
community children, even when the mother’s own internal attachment
representation has been categorized as insecure.77
In observing the interactions of mother and child and labeling some mothers’ attachment style as
insecure, this study concurrently serves to further categorize some inmates’ psychology as
somehow unhealthy, yet it also provides the hope that even these deviant women might still be
able to forge strong, intimate connections with their infants (and for healthy citizens). This study,
along with other research legitimizing prison nurseries as efficacious, contributes to a growing
body of work suggesting that prison nurseries may be helpful for the well-being of the mother
and child.
In addition, others like Chandra Kring Villanueva advocate for further “scientific”
research to help prove the efficacy of such reforms to current prison models:
Fund scientific research, participatory action research, and program
evaluations of prison nurseries and community-based residential parenting
programs to reveal best practices and the potential benefits of system reforms.
-There have been very few evaluations and scientific research
studies conducted of prison nursery programs and even fewer
of community-based mother-child programs. Through research,
best practices and needed reforms can be identified and
implemented.78
Although Villaneuva does not define “scientific” research per say, the use of this word likely
indicates a continuation of quantifying programs’ worth through surveys and other measures that
M. W. Byrne, L.S. Goshin, and S.S. Joestl, “Intergenerational Transmission of Attachment for Infants
Raised in a Prison Nursery,” Attachment & Human Development 12, No. 4 (2010), 375-393.
78
Villanueva, “Mothers, Infants and Imprisonment,” 7.
77
27
easily fit into a biomedical model framework within public health initiatives. Moreover, these
recommendations not only reify the importance of healthcare research (and funding for this
research) but the research it produces can also serve as evidence for advocates, policy makers,
and politicians to implement laws establishing further administrative growth in creating spaces in
prison for inmates to mother infants.
From this discussion, it is evident that the goal of fostering prison nurseries is quite
multiplicitous. Villaneuva demonstrates both the overt and covert implication of such programs
when she writes, “The primary goal of most prison nursery programs is to promote bonding
between mothers and children while giving mothers tools to become better parents. A secondary
goal is to reduce recidivism among incarcerated mothers by encouraging them to make lifestyle
changes following release.”79 In both justifications, the disciplining of the mother is still
implicit—bonding can be seen as an instrumental technique to also incorporate moralizing
programs on motherhood and “proper” (read “civilized”) childrearing techniques. In addition,
their encouragement to make “lifestyle” changes again furthers neoliberal discourses on
individual blame for criminalization, while ignoring the larger structural factors that contribute to
the criminalization certain behaviors (or phenotypes) in the first place.
Finally, Joseph Carlson Jr. claims that prison nurseries “a pathway to crime-free futures.”
While he may seem quite idealistic in his proclamation, he does note that lower rates of
recidivism are correlated with the installation of prison nurseries:
Ten states have begun prison nurseries, with more states considering
that option. It is recognized that a nursery program will not solve all
of the problems of participants, but it is apparent that it will reduce
recidivism. It is believed that in the future nursery programs will
become a more normal part of prison operations, and it is in the best
interests of states, inmates and their babies to move quickly in this
79
Ibid., 15.
28
direction.80
Again, throughout his article, Carlson does not refer to “problems of participants” as structural
issues, but emphasized individual psychological dynamics of engagement.81 Moreover, his
pronouncement of prison nurseries as programs that would be in the “best interests of states”
could be read as a thinly veiled comment on the high financial cost of incarceration.82 Finally, it
seems that he conflates the “best interests” of the mother and infant with an idea of “good”
citizenship to the State, and the question remains if urgency in Carlson’s tone is truly considering
the best options for mothers and their children or if he is placing more value on the bottom line
of the state.
With thirteen states now running such programs, it is likely that more systems for
housing children with inmates will continue to spread across the country.83 Through the
techniques of incorporating scientific research and psychomedical language mentioned above,
researchers and policy makers generate the proliferation of biomedical discourses in public
spheres. While these programs may foster strong relationships between mothers and infants in
prison, perhaps a higher level intervention will be necessary to promote larger reconceptualizing
female criminality and the role of the prison.
Joseph R. Carlson Jr., “Prison Nurseries: A Pathway to Crime-Free Futures,” Corrections Compendium
34, Issue 1 (Spring 2009), 17-24.
81
Ibid.,
82
* In support of prison nurseries, Gilad and Gat note that sending a child to foster care cost about $40,000,
while keeping them at a prison nursery averages to $11,000. Lastly the state can save about $29,000 per woman
each year by lower their recidivism rate. See Michal Gilad and Tal Gat, “U.S v. My Mommy: Evaluation of Prison
Nurseries as a Solution for Children of Incarcerated Women,” New York University Review of Law and Social
Change 36 (2012), 32.
83
* Although prison nurseries existed intermittently in U.S. prisons as early as the 1840s, they were often
insufficiently staffed and overcrowded. Through fostering inmates’ maternal feelings and contributing to a domestic
environment, wardens believed then (as they do now) that they could reform inmates’ character. See Freedman,
Their Sisters’ Keepers, 48 and 95.
80
29
Conclusion
The moralizing discourses within scientific research continue even now. From this brief
survey of literature on mothering in and out of prison, data acquired by medical authorities and
social researchers is used to legitimate normative value judgments on policies enacted by
correctional facilities. Moreover, mothering as a public affair in prison becomes a site of open
investigation and findings further validate methods of surveillance condoned by the medical
establishment. Tracing the recent increase of prenatal care, the rise of the unshackling movement
during delivery, and the development of prison nurseries/residency programs, arguments made
by the medical establishment to “improve” living conditions for pregnant prisoners can be seen
in the larger context of their support of prison institutions as a means to increase their influence
and impose their control over women’s bodies.
From these examples, it becomes clear that the encroachment of the medical
establishment upon the sphere of law, while potentially beneficial in improving birth outcomes,
may also create a space in which surveillance of women’s bodies is scrupulously monitored and
controlled. The freedom then to express one’s lived experience of pregnancy with a health care
professional at a prison hospital can also be seen as a means to further stigmatize their
“deviance.” Although the movements outlined above provide only small examples in history of
the gradual push among the medical establishment to more fully control motherhood in prison,
this will to power is not without its difficulties, and may, in some instances, create even greater
restrictions on women’s limited sense of autonomy in prison.
30